David Satcher traveled the globe as part of a World Health Organization commission investigating health inequalities in places such as Kenya, China and Brazil.
But rather than prescribing high-tech treatments to improve the lives of some of the world’s poorest residents, the commission recommended addressing basic human needs: cleaner water, better education and improved access to healthy food.
“Most of the time the leaders of a country who wanted to improve public health would be thinking about things like building more hospitals,” said Satcher, who served as U.S. surgeon general from 1998 to 2002. “But it was clear to us that they needed to target safe water and early childhood education as some of their primary health interventions.”
Satcher, who served as Centers for Disease Control director from 1993 to 1998 and was assistant secretary for health under President Clinton, now heads the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta.
The former surgeon general was in North Carolina recently to deliver the 6th annual Global Health Lecture at Duke University’s School of Nursing and spoke with The News & Observer. He said health equity is a pressing problem for much of the world’s population – as well as for people in many parts of the United States.
“There are some places where it’s not safe to walk out on the porch, let alone go for a walk around the neighborhood,” Satcher said. “In some communities, you can buy cigarettes or lottery tickets, but you can’t find a place to buy groceries.
“It often comes down to social determinants – making sure people have access to healthy lifestyles.”
A shortage of doctors in rural areas means routine care and preventative education often are lacking.
“To have one family physician in an area can make a big difference,” Satcher said.
Access to important preventative screenings, such as mammograms and annual physical exams, has been out of reach for many low-income families. Satcher thinks coverage for preventative care – largely without the requirement of a co-pay – is “one of the real strengths” of the Affordable Care Act.
The U.S. Department of Health and Human Services has awarded $1.25 billion in Prevention and Public Health funds to states since 2010. Much of that funding is aimed at prevention programs that target chronic ailments, such as heart disease, cancer and diabetes, which are responsible for 70 percent of deaths and 75 percent of health care spending in America.
North Carolina has been awarded $39 million in prevention funds so far, including $8.7 million in community transformation grants for smoking cessation, obesity prevention and similar programs; $9.5 million in clinical prevention grants to improve access to routine screenings and other health care services; and $10.7 million to support training of public health providers.
Spending on prevention efforts will ultimately save money, Satcher thinks.
“Maybe not right away, but over the longer term,” he said.
“It’s important to focus what you can do in your community and home – and there has not been a focus on those kinds of things in the past.”
Satcher also thinks education is vital to good health, beginning at an early age, as educated individuals make better choices and have a better chance at becoming economically stable adults.
In Chile, an early childhood development program the World Health Organization commission visited led to lower health care costs and shrunk incarceration rates significantly over time.
A similar approach, in an area of Atlanta where 80 percent of children came from single-parent households, produced unexpected but welcome results, Satcher said.
“We found that access to quality early childhood education benefits the parents as much as it does the children,” Satcher said. “Depression is a major problem in the black community for women. We found a decline in depression among women in the program. It gave them more options, helped them feel better about themselves, and they gained a network of support.”
He said the National Institutes of Health has recently given Morehead School of Medicine the go-ahead to launch a health promotion and disease prevention project in underserved communities, including some in North Carolina. Details of the program are now being developed.
“We want to focus on communities where the need is greatest and see if we can make a difference,” Satcher said.